The yin and yang of safety and risk: a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabilitation literature
The yin and yang of safety and risk: a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabilitation literature
Many people feel unprepared for life following discharge from stroke services. Rehabilitation occurs within a harm-reduction framework, but evidence suggests risk-taking is crucial for recovery. The aims of this review study were to explore how risk is conceptualised in the stroke rehabilitation literature and to develop a critical narrative synthesis of articles exploring and challenging dominant conceptualisations of risk, in the context of post-stroke identity and engagement in valued activities. We undertook a literature search (including Embase, PubMed, CINHAL and PsycINFO), including qualitative, quantitative and mixed-methods studies in post-stroke adults > 18 years. Phase 1 involved a content analysis, with 1420 articles screened and 246 included. Most (n = 233) were described by the theme ‘Safety first’, divided into sub-themes: i) Physical safety; ii) Societal and organisational protection; and iii) Cognitive, affective and communication risks. Remaining articles were described by Theme 2: ‘Taking risks as necessary and subjective’. Critical narrative synthesis in Phase 2 included fifteen articles, demonstrating the imposition of ‘rules’ for safety, despite risk-taking being important. The predominant narrative prioritised safety and harm-reduction during stroke rehabilitation, overlooking unintended consequences for post-stroke identity and engagement in valued activities. The voice of people post-stroke was largely absent in decision-making around risk prioritisation and management, which often failed to acknowledge the inherent uncertainties and sociocultural factors influencing beliefs and behaviours in relation to risk. Further qualitative research is needed to understand the experiences of people post-stroke and to inform service co-design and shared decision-making in relation to risk in stroke rehabilitation.
Conceptualisation, Identity, Risk, Stroke rehabilitation, Uncertainty, Valued activities, stroke rehabilitation, identity, risk, uncertainty, conceptualisation, valued activities
276-314
Jackson, Shae
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Demain, Sara
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O'Malley, Francine
8942b520-614a-47ac-b131-6d793b01a2d5
Kunkel, Dorit
6b6c65d5-1d03-4a13-9db8-1342cd43f352
2025
Jackson, Shae
d2aeb662-349e-4592-8dd9-e2403e90703d
Demain, Sara
09b1124d-750a-4eb1-90c7-91f5f222fc31
O'Malley, Francine
8942b520-614a-47ac-b131-6d793b01a2d5
Kunkel, Dorit
6b6c65d5-1d03-4a13-9db8-1342cd43f352
Jackson, Shae, Demain, Sara, O'Malley, Francine and Kunkel, Dorit
(2025)
The yin and yang of safety and risk: a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabilitation literature.
Health, Risk & Society, 27 (5-6), .
(doi:10.1080/13698575.2025.2535973).
Abstract
Many people feel unprepared for life following discharge from stroke services. Rehabilitation occurs within a harm-reduction framework, but evidence suggests risk-taking is crucial for recovery. The aims of this review study were to explore how risk is conceptualised in the stroke rehabilitation literature and to develop a critical narrative synthesis of articles exploring and challenging dominant conceptualisations of risk, in the context of post-stroke identity and engagement in valued activities. We undertook a literature search (including Embase, PubMed, CINHAL and PsycINFO), including qualitative, quantitative and mixed-methods studies in post-stroke adults > 18 years. Phase 1 involved a content analysis, with 1420 articles screened and 246 included. Most (n = 233) were described by the theme ‘Safety first’, divided into sub-themes: i) Physical safety; ii) Societal and organisational protection; and iii) Cognitive, affective and communication risks. Remaining articles were described by Theme 2: ‘Taking risks as necessary and subjective’. Critical narrative synthesis in Phase 2 included fifteen articles, demonstrating the imposition of ‘rules’ for safety, despite risk-taking being important. The predominant narrative prioritised safety and harm-reduction during stroke rehabilitation, overlooking unintended consequences for post-stroke identity and engagement in valued activities. The voice of people post-stroke was largely absent in decision-making around risk prioritisation and management, which often failed to acknowledge the inherent uncertainties and sociocultural factors influencing beliefs and behaviours in relation to risk. Further qualitative research is needed to understand the experiences of people post-stroke and to inform service co-design and shared decision-making in relation to risk in stroke rehabilitation.
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The yin and yang of safety and risk a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabil
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Accepted/In Press date: 11 July 2025
e-pub ahead of print date: 25 July 2025
Published date: 2025
Keywords:
Conceptualisation, Identity, Risk, Stroke rehabilitation, Uncertainty, Valued activities, stroke rehabilitation, identity, risk, uncertainty, conceptualisation, valued activities
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Local EPrints ID: 505739
URI: http://eprints.soton.ac.uk/id/eprint/505739
ISSN: 1369-8575
PURE UUID: de785f9b-3819-4563-9963-7cd349c06683
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Date deposited: 17 Oct 2025 16:35
Last modified: 06 Dec 2025 03:02
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Author:
Shae Jackson
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